The role of primary health in Nigeria’s health sector value chain

Primary healthcare is the most critical stage in healthcare service delivery; it is the first level of contact at the community level with a healthcare facility. At this level, minor health challenges with the potential of becoming life-threatening are detected early, treated, or referred.

Nigeria adopted the primary healthcare system in 1978, following the Alma-Ata Declaration, which identified primary healthcare as the key to attaining the goal of Health for All. Recognising that primary health care forms an integral part of any country’s health system, the health administration of the late Professor Olikoye Ransome-Kuti in 1985, established the first sets of Primary Health Centres (PHC) in 52 local government areas of the country and spread to all local governments within five years.

Thirty-seven years later, there are over 30,000 primary health centres. Unfortunately, only about 20 percent are functional, which can be detrimental to the health sector.

The World Health Organisation (WHO) affirms that standard, well-equipped (PHCs) can manage illnesses and prevent them through health promotions, community, and house-to-house outreaches. They also prevent the pressure and substantial burden on secondary and tertiary health facilities.

The WHO also reports that about 930 million people worldwide are at risk of falling into poverty due to out-of-pocket healthcare spending of 10 percent or more of their household budget. In this regard, scaling up primary health care interventions (with universal health coverage – UHC) across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.

At the UN High-Level Meeting (UN-HLM) on Universal Health Coverage (UHC) during the United Nations General Assembly (UNGA) week in 2019, member states made a Political Declaration and reaffirmed their commitment to the UHC. This resolution, according to WHO, was particularly significant as it raised the hope of the 3.65 billion people who currently lack affordable and accessible quality healthcare services.

In addition, member states committed to primary health care renewal and implementation as the cornerstone of a sustainable health system for the UHC, health-related Sustainable Development Goals (SDGs) and health security. Achieving universal health coverage (that is, ensuring that people can easily access the healthcare services they need without paying too much) is one of the ambitious targets of the 2030 agenda for sustainable development.

However, for universal health coverage (UHC) to be truly ‘universal’, we need our health systems to move closer to the people. To achieve this, WHO recommends an additional investment of about $200 billion to $370 billion a year to achieve the targets for health systems to be closer to people. As a result, the WHO advocates that every country allocates or reallocates an additional 1 percent of GDP to PHC from government and external funding sources.

Following this recommendation, members of the African Union (AU) agreed to increase their healthcare budget to at least 15 percent of their annual budget at the Abuja Declaration in 2001.

However, by 2018, the United Nations reported that only two African countries (Rwanda and South Africa) reached the target, while 19 had reduced their health budget. Other countries, like Nigeria, had not had a noticeable negative or positive trend evident in the country’s 2022 budget; healthcare allocation is N194.6 billion out of a national budget of 17.1 trillion, which is about 4% allocation, in variance with the recommendation by WHO.

For this reason, the private sector must be encouraged to partner with the government to fund the health sector. While we have witnessed private sector interventions for polio eradication, malaria, Ebola and the recent COVID-19 pandemic in the past, there is a need for more to be done to strengthen the PHCs. The PHC interventions can help upgrade the PHC facilities, install high-tech equipment to improve services, provide necessary medication, compensate healthcare workers, and capacity building training.

For primary healthcare centres to receive the attention it needs, all stakeholders must understand the institution’s importance to the health sector value chain, especially to health promotion, prevention, and early diagnosis. In addition, our dependence on treatment, especially in high-cost medical settings, has to be re-evaluated, and the private sector needs to lead on this drive because they have built an efficiency culture over time. Furthermore, there must be equitable distribution of PHCs in rural and urban areas to allow for cross-subsidization and effective financing models like community-based insurance as a sustainability driver.

This is critical, especially since the Nigerian Medical Association (NMA) confirmed an increase in Nigerians diagnosed with kidney disease and various cancers. This situation points to the failure of primary health care because these diseases are lifestyle-based and worsen over time due to late detection. On the other hand, if diseases are detected and treated on time, it can reduce their chances of escalating and becoming deadly and, ultimately, reduces the pressure on secondary and tertiary centres.

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In the last decade or so, some private organisations/individuals have risen to the challenge, complementing the government’s effort by reviving the primary health care system. Famacare is one of such, and since its establishment in 2019, the organisation has sought to provide quality primary healthcare services with cutting-edge medical technology at an affordable cost to people in densely populated areas. We operate from two centres in Lagos – Egbeda and Abule-Egba in Alimosho LGA, which has the largest population in Lagos State.

As a private primary healthcare provider, we strive to complement the government efforts by supporting the National Primary Healthcare Development Agency (NPHCDA) in immunisation, reducing maternal and child deaths, preventive medicine, providing healthcare services at the grass-root and other strategic goals of the agency.

Over the past three years, we have also invested in building the capacity of healthcare workers in partnership with experts.

We are, however, aware that there is more to be done; hence, we have identified other densely populated locations across the six geo-political zones of Nigeria to set up more of these clinics. We strive to ensure that our host communities are healthy and thrive while enabling healthy economic activities.

At Famacare, our mantra is ‘Everyone Deserves Care’ irrespective of socioeconomic status, gender, or geographic location. Therefore, we ensure access to basic healthcare services through our physical centres and digital channels. This will significantly curb morbidity, premature death and increase national life expectancy, supporting the Alma Ata Declaration that health care is a fundamental human right. Hence, access to quality healthcare should be affordable and within reach.

Ofulue, founder and CEO, Famacare, writes from Lagos

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